"Since the report came out, a lot has happened as far as the epidemic spreading, but very little has been done to implement the strongly felt recommendations of the panel," said June Osborn, dean of the University of Michigan School of Public Health and a member of the group that prepared the report. The necessary federal leadership is lacking, added Irving Weissman of Stanford University, who also participated in the intensive six-month study.
Samuel Thier, president of the Institute of Medicine, said he is particularly disappointed with the slow response to the committee's recommendation to coordinate research efforts among federal agencies better. But he pointed to some movement in Congress.
Sen. Pete Wilson (R-Calif.) has just introduced a bill that directs the Institute of Medicine to create a 10-member AIDS advisory panel that would report regularly to the president and Congress for at least the next five years. The panel would make use of experts in government, industry and academia to collect data, issue reports and would be the leading voice on the disease, said Bruce Millis, a legislative assistant for Wilson.
Rep. Jerry Lewis (R-Calif.) and Sen. Ted Stevens (R-Alaska) have introduced separate bills to create a presidential commission of Cabinet officials and AIDS experts to conduct an 18-month study of the efforts to fight the disease.
Observers find fault with each proposal. "We recommended a standing presidential or joint presidential/congressional commission that would act over the term," said Weissman. "Nothing suggested so far sounds appropriate."
Robert Raybin, assistant director for life sciences at the White House Office of Science and Technology Policy, said that the Institute of Medicine's report was complete and useful and that "we certainly don't need another one. We'll decide very soon how to respond."
From the Same Pocket
Weissman said this move indicates that the panel's belief in the importance of building a know!edge base, and in funding basic as well as applied research, is being ignored. "We know nothing of the pathogenesis of the disease, and we're not putting ourselves in a position to understand it any time soon," he said.
Sen. Lowell Weicker (R-Conn.), a co-sponsor of the Wilson bill, agreed with the Institute of Medicine panel that AIDS research should not be funded with money from other programs. "It's not just that you can't rob Peter to pay Paul," said Steve Snider, press secretary for Weicker. "This is robbing Peter and Paul."
Raybin defended the administration's budget for biomedical research. "If you balance GrammRudman, the federal deficit and other cost-cutting measures," he said, "basic research is not faring badly at all."
The 1990 goal could well be met despite those fiscal constraints, predicted NIH Director James Wyngaarden during a meeting last month in Chicago of the American Association for the Advancement of Science. Funding for AIDS research is on its way up, noted the University of Michigan's Osborn, who added that "the current rate of progression would approximate a figure close to the $1 billion mark by 1990."